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Illustration showing the categories of root canal morphologies in human permanent teeth according to the method by Vertucci.
Source publication
Background
We investigated the root canal curvature and morphology of maxillary posterior teeth in Guizhou, China, to provide references for clinical practice.
Material/Methods
We collected 274 maxillary posterior teeth in Guizhou Province, China. The root canal curvature was observed by X-ray film measurement. Two hundred teeth were selected to m...
Context in source publication
Similar publications
Proper knowledge of the anatomic structure of the root canal system is a vital prerequisite for successful root canal therapy. This report presents the endodontic management a two-rooted lower first premolar with five root canals. A similar case has not been reported to date. The use of volumetric or cone-beam CT in rare and doubtful cases helps es...
Citations
... 7 Therefore, the radiographic assessment of root curvatures through clinical practice is crucial before treatment commencement. 8 Earlier studies applied different approaches to determine root canal curvature involving periapical radiography, transparent tooth techniques, and microcomputed tomography. 9 In 2008, Estrela et al 10 suggested the utilization of cone beam computed tomography (CBCT) for finding anatomical and pathological changes, as opposed to periapical radiography, which fails to show curvatures in a three-dimensional direction. ...
Aim: This cross-sectional study aims to analyze the mesiobuccal (MB) root canal curvature in maxillary molars of the Egyptian population using cone-beam computed tomography (CBCT). Material and methods: DICOM files were retrieved anonymously from three different radiology centers according to specific selection criteria. Untreated MB roots with varying degrees of curvature were assessed in the sagittal plane for angle determination. Based on Schneider's method for root canal curvature assessment, a standardized protocol was developed by an oral and maxillofacial radiologist and was applied by two endodontists independently. The degree of severity was defined according to the American Association of Endodontists (AAE) case difficulty assessment form. Data was tabulated and analyzed, and its clinical relevance was assessed. Data from 192 CBCT scans were collected and statistically analyzed using chi-square and independent t-tests. Results: The average angle of curvature of the mesiobuccal (MB) root of the maxillary first molar (MFM) in the sagittal plane was 22.8 degrees with a standard deviation of 9.8. In contrast, the maxillary second molar (MSM) was 24.3 degrees with a standard deviation of 10.5. No significant difference between the mean angles of the two molars was detected (p = 0.157). Most roots showed a moderate curvature, falling between 10 and 30 degrees (69.3% for MFM and 66.7% for MSM). Conclusion: In the Egyptian population, most MB roots of the upper first and second molars showed moderate to severe curvatures.
... The cleanliness of the retreatment procedure in the present study may be due to the approximate sizes of the NiTi rotary files and root canals. Therefore, the results of this study can only be generalized to retreating teeth with small curved root canals, such as the mesial root of the mandibular molars and the buccal roots of the maxillary molars [21,22,39]. However, X2 with continuous rotation and RB files can be used for penetrating to the working length of a curved canal in the original canal path without complications. ...
Background
It is currently unknown whether rotary file motion affects the best outcome of root canal retreatment. This experimental study compared the efficacy, efficiency, and complications of single-use NiTi rotary files using continuous rotation, reciprocating, and adaptive motions in root canal filling removal in curved root canals. Reciproc blue R25 was used with reciprocating motion (RB), VDW.ROTATE retreatment files with continuous rotation (VR), and ProTaper NEXT X2 with continuous rotation (PTNc) or adaptive motion (PTNa).
Methods
Forty mesial root canals of extracted mandibular first and second molars with an angle of curvature between 20°–40° and a radius of curvature between 5 and 10 mm were collected. The specimens were instrumented and obturated with gutta-percha and AH Plus sealer using the continuous wave of condensation technique. The specimens were randomly divided into 4 retreatment groups (n = 10), RB, VR, PTNc, and PTNa. The percentage of root canal filling removal in each group was analyzed using Micro-Computed Tomography (µCT). The motor running time, total time, root canal complication, and instrument complication were recorded and statistically analyzed (p-value < 0.05).
Results
The pre-operative root canal curvature and root canal filling volume were comparable among groups. The percentage of root canal filling removal from the whole canal in the PTNc, RB, PTNa, and VR group was 98%, 96%, 95%, and 93%, respectively. A significant difference was observed between the PTNc and VR groups for the whole canal and the apical-third part. The motor running time and total time were significantly different between the groups. Instrument fracture was observed at 40% in the VR and 20% in the PTNa group, but none in the RB and PTNc groups.
Conclusions
The ProTaper NEXT X2 with continuous rotation and RB files can be used with high efficacy and efficiency in curved root canal retreatment. Continuous rotation is more efficacious and efficient than adaptive motion when using the NiTi rotary file. Single file retreatment can be used in small canals with high efficacy, cost-effectiveness, and less time consumption.
... Incomplete curvature assessment holds significant clinical implications, leading to potentially inaccurate assessments of case complexity and the potential for intraoperative complications. Notably, the mesiobuccal roots of maxillary molars are known to frequently present severe curvatures in multiple planes [22][23][24][25] . As such, three-dimensional evaluations of such root canal systems can be beneficial. ...
Abstract
Introduction
This study aimed to compare the curvature severity of MB canals between sagittal and coronal planes using cone-beam computed tomography.
Methods
In a Brazilian subpopulation, untreated MB1 (n=141) and MB2 (n=72) with single curvatures in sagittal and coronal planes were measured to determine their angle and radius (r), plus the incidence of S-shaped canals was recorded. Curvature severity was defined according to the American Association of Endodontics Case Difficulty Assessment form (AAE) and EndoApp (EA), as well as their modified versions that consider angle and radii (AAE-r, EA-r). Data were converted into mean angle and radius, percentage of canals >30º, AAE, EA, AAE-r and EA-r categories. The influence of radius on case severity was assessed. Statistical analysis was performed using t-tests and chi-squared tests. The level of significance was set as p≤0.05.
Results
For single curvatures, significantly higher mean degrees (SD) angles were found in the sagittal views in both canals [MB1 sagittal: 35 (11); MB1 coronal: 13 (13); MB2 sagittal: 29 (14); MB2 coronal: 22 (15) (p<0.05)]. A greater percentage of angles >30º (MB1: 56.7% vs 6.4%; MB2: 44.4% vs 22.2%) in sagittal planes compared to coronal planes was also found. Conversely, a higher prevalence of S-shaped canals (MB1: 33.3% vs 7.1% MB2: 31.9% vs 15.3%) was observed in coronal planes. Significant differences between AAE and AAE-r were present with greater case severity when radii were considered (p<0.05).
Conclusions
Sagittal planes were associated with more severe single curvatures, while coronal planes had a greater incidence of S-shaped canals.
... The limitation of the current study was that the cleanliness of the retreatment procedure in the present study may be due to the approximate sizes of the NiTi rotary les and root canals. Therefore, the results of this study can only be generalized to retreating teeth with small curved root canals, such as the mesial root of the mandibular molars and the buccal roots of the maxillary molars [14,15,23]. However, X2c and RB can be used for penetrating to the working length of a curved canal in the original canal path without complications. ...
Objectives
Study compared efficacy, efficiency, and complications of curved root canal retreatment using single-use NiTi rotary files with different motions.
Materials and Methods
Forty mesial curved root canals of extracted mandibular molars, obturated with gutta-percha and AH Plus sealer, were randomly divided into four groups. Reciproc blue R25 was used with reciprocating motion (RB), VDW.ROTATE retreatment files with continuous rotation (VR), and ProTaper Next X2 with continuous rotation (X2c) or adaptive motion (X2a). The percentage of root canal filling removal was analyzed using Micro-Computed Tomography. The retreatment time and complications were recorded and statistically analyzed (p-value < 0.05).
Results
The study found a statistically significant difference in the percentage of root canal filling removal between the X2c and VR groups in both the whole canal and apical-third. Additionally, VR demonstrated a shorter retreatment time compared to RB and X2a. Instrument fracture occurred in 40% of the VR group and 20% of the X2a group.
Conclusions
X2 (continuous rotation) and RB files are highly effective and efficient for curved root canal retreatment. Continuous rotation is more efficacious and efficient than adaptive motion with NiTi rotary files.
Clinical Relevance
Single-file retreatment is highly efficacious, cost-effective, and time-efficient in small curved canals.
... Over the last two decades, micro-CT technology has been increasingly used to investigate a wide range of internal and/or external root and canal anatomical features in different tooth types. It has been evidently reported that micro-CT is referred to be as, compared to CBCT and other earlier evaluation modalities, the "gold standard" in investigating the canal length [38], cross-sectional shape [39], canal configuration [40,41], apical deltas and number of foramen [42], canal curvature [43], isthmus [44], and intercanal communication and accessory canals [45]. Its non-destructive nature and reproducibility, smaller voxel size, higher spatial resolution, higher degree of rotation (360°), and thinner slice thickness contribute to its powerful ability to accurately identify extremely fine and highly complicated anatomies. ...
Background
A thorough understanding of root and canal anatomy is crucial for successful root canal treatment outcomes. This systematic review aims to explore the published micro-CT studies investigated the anatomy of root and canal system in permanent mandibular first molars.
Method
An electronic search was performed on Web of science, PubMed, and Scopus. Micro-CT journal studies investigated the root and canal anatomy of permanent double-rooted mandibular first molars were included. Data on study characteristics, objectives of interest, specifications of the studies, and micro-CT specifications were extracted. Risk of bias assessment (ROB) of the included studies was performed using Anatomical Quality Assessment (AQUA) tool. The extracted data were presented in tables and figures to present and synthesise the results. A meta-analysis was performed for the studies related to the prevalence of Vertucci's canal configurations, middle mesial canal (MMC) configurations, and Fan's isthmus types.
Results
Amongst 1358 identified studies, thirty met the inclusion criteria. In terms of the objectives, the selected studies showed high anatomical variability in mandibular first molars. Twenty-two (73%), 25 (83%), and 12 (40%) of the studies reported the population/ethnicity, micro-CT specifications, and ethical approval, respectively. 28 (93%) studies did not disclose the method of sample size estimation. In only 6 (20%) of the studies, the authors had calibrated the assessment approaches. Mostly, a potential ROB was reported in domain 1 (objective(s) and subject characteristics) and domain 3 (methodology characterization). Whilst, low risk was reported in domains 2 (study design), 4 (descriptive anatomy), and 5 (reporting of results). The overall ROB was reported to be ''moderate'' in the vast majority of the studies (27/30). Meta-analysis results showed high levels of heterogeneity among the studies related to MMCs (I 2 = 86%) and Fan's isthmus (I 2 = 87%). As for the root canal configuration, pooled prevalence showed that Vertucci type IV and type I were the most prevalent in mesial and distal root canals, respectively.
Conclusion
Based on moderate risk of bias level of evidence, micro-CT studies have shown wide range of qualitative and quantitative data presentations of the roots and canals in mandibular first molars.
Protocol and registration.
The protocol of this systematic review was prospectively registered in the Open Science Framework database ( https://osf.io ) on 2022–06-20 with the registration number 10.17605/OSF.IO/EZP7K.
... Currently, research methods used to evaluate root canal anatomy include the transparent tooth method and digital imaging methods such as radiography, cone beam computed tomography (CBCT), and micro-computed tomography (micro-CT). 14,16,17 The transparent tooth method is a specialized technique for transforming an isolated tooth into a permanently transparent specimen, to directly observe the root canal shape. However, the fabrication process of transparent teeth is extremely complex. ...
... This suggests that MB2 can be located based on the location of MB canal, which confirms the validity of Shen et al.'s results. 17 The axial curvature of the coronal root canals of maxillary first molars was larger in the buccal root canals and smaller in the palatal root canals, which is consistent with the findings of Qiao et al. 14 However, in the present study, the mean axial curvature was larger. This difference might be due to variations in measurement methods. ...
Background
The design of minimally invasive access has become a hotspot. This study aimed to evaluate the coronal root canal morphology of permanent maxillary first molars to facilitate the design of endodontic access cavities for minimally invasive linear access.
Materials and methods
A selection of 91 permanent maxillary first molars was evaluated. Three-dimensional tooth models were reconstructed using micro-computed tomography data. Root canal prevalence and coronal root canal landmarks were recorded. The positional coordinates of landmarks in the horizontal plane and the angles and directions of coronal root canal curvature in the horizontal and axial planes were also assessed.
Results
The detection rates of the mesiobuccal (MB), distobuccal (DB), and palatal (P) canals were 100%, whereas that of the second mesiobuccal (MB2) canals was 68.1%. All landmarks were located near the central fossa. In the axial plane, the average angles of coronal root canal curvature were DB (27.05°) > MB (25.43°) > P (20.71°) in teeth with three canals, and MB2 (33.20°) > MB (29.61°) > DB (28.40°) > P (23.69°) in teeth with four canals. In the horizontal plane, the average angles were P (78.15°) > DB (42.34°) > MB (32.41°) in teeth with three canals, and P (81.26°) > DB (43.44°) > MB (41.22°) > MB2 (9.41°) in teeth with four canals.
Conclusion
In maxillary first molars, coronal root canals tend to converge towards the occlusal surface. The results of this study could be applied to improve the precision of endodontic access cavity designs of minimally invasive access.
... Failure of endodontic treatment has various reasons, one of which is undetected or missed canals due to complex morphology [3]. Untreated root canals act as reservoirs for bacterial growth which eventually leads to treatment failure [4][5][6]. ...
Adequate knowledge of root canal morphology along with its probable variations is imperative to acquire successful endodontic treatment. This retrospective cross-sectional study aimed to investigate the root canal configuration of maxillary and mandibular first molar using Cone-Beam Computed Tomography (CBCT) among patients in Al-Ahsa region, Saudi Arabia. A total of 377 samples were included, out of which 123 CBCT (I-CAT Vision QTM) scans with intact all first permanent molars were selected in this study and scanned in sagittal, axial, and coronal views by using BlueSkyPlan software. The number of canals in each root and their configuration according to the Vertucci classification system was evaluated. Statistical analysis was analyzed using SPSS version 21 (IBM). Chi-square test was applied to evaluate the association of root canal morphology and mandibular and maxillary first molars with respect to gender. Out of 123 CBCT scans, 59 (48.0%) were males and 64 (52.0%) were females; the mean age was 26.95 ± 10.65 years. The mesiobuccal root of bilateral maxillary first molar had Type-I (87.0%) of Vertucci classification followed by Type-IV (9.8%). Additionally, all mesiobuccal roots (100%) of the left mandibular first molar had Type-I of Vertucci's classification. A significant association has been observed between gender and a number of canals in bilateral maxillary first molars. Females showed a significantly higher prevalence of three-root canal configuration in maxillary first molars of both sides compared four canals found most commonly in males (p = 0.004). This study concluded that the majority of maxillary and man-dibular permanent first molars had three roots and three canals with Type-I Vertucci's classification in patients belonging to the Al-Ahsa region of the Saudi Arabia. It was also proved that gender is significantly associated with the number of canals in a bilateral maxillary molar.
Background
Understanding the tooth anatomy is crucial for ensuring effective endodontic treatment. This study investigated the root canal morphology of the second mesiobuccal (MB2) canal in maxillary first molars (MFMs) in a Chinese population using cone-beam computed tomography (CBCT).
Methods
This study evaluated 486 MFMs with MB2 canals from 285 participants undergoing CBCT examination and determined the Vertucci’s classification and position of the MB2 canal orifice. The prevalence of the MB2 canal was correlated with the sex, age, and tooth side. The correlations between the prevalence of the MB2 canal and sex and tooth side were assessed using the Fisher's exact test. The chi-square test was used for evaluating the correlation between the prevalence of the MB2 canal and age.
Results
The number of type II, III, IV, V, VI, VII, and other root canals in the MFMs was 30.9%, 0.6%, 65.0%, 1.2%, 1.2%, 0.4%, and 0.6%, respectively. Among the 201 cases with bilateral inclusion, 87.6% showed consistent canal configuration. Results of the first clear apparent position (FCAP) of the MB2 canals showed that 434, 44, and 3 teeth had FCAP at the upper, middle, and bottom one-third of the root, respectively. The FCAPs of the MB2 canal in the MFMs with types II, IV, and VI, as well as types III and V canals showed significant differences (p<0.05). The horizontal distance between the MB1 and MB2 canal orifices in the type II canals of MFMs was significantly lesser than those in the type IV canals of MFMs (p < 0.01). The longitudinal distance between the pulp chamber floor plane and MB2 canal orifice significantly correlated with age (p < 0.05).
Conclusions
The morphology of the mesiobuccal root canal in the MFMs is complex. Complete understanding of the anatomical morphology of the root canal combined with the CBCT and dental operating microscope is necessary for the accurate detection of the MB2 canal and consequently improved success rate of root canal treatment. Our study findings can help endodontists improve endodontic treatment outcomes.
Răng hàm nhỏ (RHN) là nhóm răng có cấu trúc giải phẫu hệ thống ống tủy đa dạng, vì vậy việc điều trị tuỷ ở nhóm răng này gặp rất nhiều khó khăn. Do đó trước khi điều trị tủy, Bác sĩ Răng hàm mặt cần nhận thức đầy đủ về hình thái và khả năng biến đổi của ống tủy. Mục tiêu của nghiên cứu này là mô tả đặc điểm hình thái ống tủy nhóm răng hàm nhỏ thứ nhất trên phim CT Conebeam (CTCB). Phương pháp: Nghiên cứu thực nghiệm được thực hiện trên 51 răng hàm nhỏ thứ nhất hàm trên và 39 răng hàm nhỏ thứ nhất hàm dưới trong thời gian từ tháng 6/2021 đến tháng 6/2022 tại khoa Răng hàm mặt, Bệnh viện Đại học Y Hà Nội và Viện Đào tạo Răng Hàm Mặt – Trường Đại học Y Hà Nội. Kết quả: hầu hết RHN thứ nhất hàm trên có một ống tuỷ (86,3%), trong khi RHN thứ nhất hàm dưới có tỷ lệ một và hai ống tuỷ ống tủy bằng nhau là 46,2%. Đa phần nhóm hai chân của RHN thứ nhất hàm trên có hệ thống ống tuỷ loại I (96%) và gần một nửa nhóm một chân của RHN thứ nhất hàm dưới có hệ thống ống tuỷ loại I (47,4%) hoặc loại V (34,2%). Phần lớn RHN thứ nhất hàm trên và dưới có độ cong vừa phải tương ứng là 86,9% và 83,6%. Kết luận: răng hàm nhỏ thứ nhất hàm trên và dưới cho thấy sự phức tạp về số lượng ống tuỷ, độ cong và hình dạng ống tủy.
Objectives
The aim of this study was to compare the occurrence of instrumentation and obturation related endodontic procedural mishaps following the use of either, stainless steel hand or engine-driven rotary instrumentation techniques.
Methods
From a computerized hospital database, a total of 730 dental patient records who had received endodontic treatment by undergraduate dental students between August 2018 to September 2020 were retrieved. The inclusion criteria were primary (non-surgical) endodontic treatment on permanent teeth with complete radiographic records. Following record screening, a final sample of n = 475 dental records were included. Radiographic records were evaluated for both instrumentation and obturation related mishaps. The data was analysed using multiple logistic regression analysis ( α = 0.05).
Results
Engine-driven rotary instrumentation resulted in a significant decrease in the overall occurrence of instrumentation related endodontic mishaps by 40% compared to hand instrumentation (Odds Ratio = 0.59 [0.36–0.97], p = 0.04). In particular, rotary instrumentation decreased ledge formation, perforation and obturation related mishaps, with minimal effect on the limitation of zipping.
Conclusion
The use of rotary instrumentation techniques may reduce the incidence of instrumentation and obturation endodontic mishaps in the undergraduate dental clinic.
